Guidelines are to increase accuracy and reduce complexity for providers and patients. 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. ASCCP, 23219 Stringtown Rd, #210, Clarksburg, MD 20871. CIN2+: this term includes CIN2, CIN3, AIS, and cancer, CIN3+: this term includes CIN3, AIS, and cancer. Repeat human papillomavirus (HPV) testing or cotesting at 1 year is recommended for patients with minor screening abnormalities indicating HPV infection with low risk of underlying CIN 3+ (eg, HPV-positive, low-grade cytologic abnormalities after a documented negative screening HPV test or cotest). revised guidelines provide a framework for incorporating new data and technologies as ongoing incremental 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. ASCCP guidance informs the assessment and treatment of abnormal cervical cancer screening results. to develop guidelines that will apply to all situations. 3. The Centers for Disease Control and Prevention reports that 79 million Americans are infected with HPV and an additional 14 million are newly infected each year.3 Data from early HPV vaccine trials suggest that the lifetime prevalence of the infection is 85% in women and 91% in men who have had at least one sex partner.8. The recommendation is more than a cytology or HPV follow up. <>>> 8600 Rockville Pike Xiaojian Chen MS; Li Cheung PhD; Kim Choma, DNP; Megan Clarke, PhD; Christine Conageski, MD; Miriam Cremer, MD, MPH; and transmitted securely. Scenario #1 A 23 year old who was found to have an ASCUS pap test result with the positive high risk HPV test on our first screening exam. cancer screening tests and cancer precursors. In immunocompetent individuals immunized before 15 years of age, a two-dose series is indicated. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. :RKA\U]57D~EGjU5=f8aiQ5\v8r*\|$;%/Se1}{W1G_I}%%[oa/UEwd\qrq^V>5^N^moO.J}].Jdw[ou+w\HY Available at. and N.W.) Although many of the management recommendations remain unchanged from the 2012 guidelines, there are several important updates (Box 1). <>>> Careers. Colposcopy standards: this term refers to the ASCCP Colposcopy Standards that provide evidence-based https://cervixca.nlm.nih.gov/RiskTables/ Risk Estimates Supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. New data indicate that a patient's Cytology every . R.B.P. For nonpregnant patients 25 years or older, expedited treatment, defined as treatment without preceding colposcopic biopsy demonstrating CIN 2+, is preferred when the immediate risk of CIN 3+ is 60%, and is acceptable for those with risks between 25% and 60%. 2020 Apr;24(2):87-89. doi: 10.1097/LGT.0000000000000531. Table 1. variables to consider, the 2019 guidelines further align management recommendations with current understanding of Pathology (ASCCP), and the American Society for Clinical Pathology.5 In this update of the ACS guideline for cervical can-cer screening, we recommend that cervical cancer screen-ing should begin in average-risk individuals with a cervix at age 25 years and cease at age 65 years and that the pre-ferred strategy for regular screening is primary HPV P.E.C. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Children and young adults age 13 through 26 who have not been vaccinated, or who haven't completed the vaccine series, should get the vaccine as soon as possible. Algorithms and/or risk estimates are shown when available. %PDF-1.5 % incorporated past screening history. J Low Genit Tract Dis 2020;24:102-31. <> 2023 Jan 3;7(1):pkac086. The updated management guidelines aim to: Although the guidelines are based on evidence whenever possible, for certain clinical situations, there is limited Most HPV-related cancers are believed to be caused by sexual spread of the virus. More frequent surveillance, colposcopy, and treatment are u/Fup : stream Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus cancer precursors. Refers to 5-year CIN 3+ risk. ASCCP supports the American Cancer Society (ACS) cervical cancer screening guidelines. Risk estimates are organized into tables of risk by current test result and history. Beyond the Management tab, there are two other tabs. cervical cancer screening have come out since 2012, such as primary HPV as a screening option for patients 25 years Allow for a more complete and precise estimation of risk, Provide more appropriate intervention for high-risk individuals, Recommend less intervention for low-risk individuals, Allow for the future addition of new risk modifiers and screening and management technologies. Journal of Lower Genital Tract Disease25(4):330-331, October 2021. Updated guidelines were needed to incorporate these changes. Unlike the 2012 ASCCP guidelines that relied on test results-based algorithms, the new consensus guidelines follow a risk-based approach to determine the need for surveillance, colposcopy, or treatment. Unauthorized use of these marks is strictly prohibited. It is also important to recognize that these guidelines should never substitute for clinical judgment. Perkins, Chelmow, Garcia, Kim, Nayar, Saraiya, and Sawaya. Provider beliefs in effectiveness and recommendations for primary HPV testing in3 health-care systems. Data is temporarily unavailable. Cervical cancer screening with Pap and/or human papillomavirus (HPV) tests is recommended starting between the ages of 21 and 25 years. Finally, both clinicians and patients need to recognize that while most cases of cervical cancer can be prevented through a program of screening and management of cervical precancer, no screening or treatment modality is 100% if 25yo Guideline IId. Why were the guidelines revised now? 2023 Jan 16;11(1):225. doi: 10.3390/biomedicines11010225. As of April 2021, the cost for the mobile app is $10. Perkins RB, Guido RS, Castle PE, et al. J Low Genit Tract Dis 2020;24:10231. Kruse GR, Lykken JM, Kim EJ, Haas JS, Higashi RT, Atlas SJ, McCarthy AM, Tiro JA, Silver MI, Skinner CS, Kamineni A. JNCI Cancer Spectr. 4 0 obj In additional to enabling the provision of more individualized clinical care, the new risk-based management paradigm will facilitate the incorporation of new screening and management technologies into clinical decision making and accommodate changes in disease prevalence over time. 1. 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. All rights reserved. All participating consensus organizations, including the Long-term surveillance after treatment for histologic HSIL (CIN 2 or CIN 3) or AIS involves HPV-based testing at 3-year intervals for 25 years, regardless of whether the patient has had a hysterectomy either for treatment or at any point during the surveillance period (CIII). 2. hb```b``a`O@(E$0v "b$3A{fn8EXZ3N?v[U}?{P_n\e has advised companies and participated in educational activities but does not receive any honoraria or payments for these activities, In some cases, his employer, Rutgers, receives payment for his time for these activities from Papivax, Cynvec, Merck, Hologic, and PDS Biotechnologies. For more information, please refer to our Privacy Policy. time: Negative HPV test or cotest within 5 years. Available at: ASCCP management guidelines app quick start guide. to develop guidelines that will apply to all situations. Demarco M, Egemen D, Raine-Bennett TR, et al. a reflex HPV test. PhD; George Sawaya, MD; Mark Schiffman, MD; Kathryn Sharpless, MD, PhD; Katie Smith, MD, MS; Elizabeth Stier, MD; Methods: HSIL Pap cases with hrHPV co-testing were retrospectively reviewed from June 2015 to September 2020 in our archive. %PDF-1.5 The goals of the ASCCP Risk-Based Management Consensus writing of manuscript, and decision to submit for publication. recommended for patients at progressively higher risk, while those at lower risk can defer colposcopy, undergo Federal government websites often end in .gov or .mil. Expedited treatment is preferred for nonpregnant patients 25 years or older with HSIL cytology and concurrent positive testing for HPV genotype 16 (HPV 16) (ie, HPV 16-positive HSIL cytology) and never or rarely screened patients with HPV-positive HSIL cytology regardless of HPV genotype. This information is not intended for use without professional advice. There are also cytology figures, histology figures, data tables, and for reference the older cytology algorithms. Women 30-65 and older who have had 3 consecutive negative Pap test and who have no history of CIN2 or 3, etc. Shared decision making should be used when considering expedited treatment, especially for patients with concerns about the potential impact of treatment on pregnancy outcomes. Risk estimates supporting the 2019 ASCCP risk-based management consensus guidelines. supported travel for their participating representatives. So we enter both of them by simply touching them. In the middle of the page, you'll notice that the patient's immediate risk is shown and it's shown in relation to a risk bar with different sorts of followup activities listed. Lower Anogenital Squamous Terminology (LAST): this term refers to two-tiered pathology criteria for Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. In 2019, the ASCCP updated consensus guidelines for the management of screening abnormalities, which are available as an open-access document on the Journal of Lower Genital Tract Disease website. 1176 0 obj <> endobj He has been the overall PI or local PI for clinical trials from Johnson&Johnson, Pfizer, Iovance, and Inovio. Uterus: A muscular organ in the female pelvis. <> Follow-up after treatment: Management of current HPV and/or cytology results for patients who have previously been treated for dysplasia. M.H.E. Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. is an ASCCP consultant of Inovio Pharmaceuticals DSMB. The National Cancer Institute (including M.S. patient's risk of progressing to precancer or cancer. MT]y_o. By using this site, you agree to the Privacy Policy and acknowledge the use of cookies to store information, which may be essential to making our site work properly or enhancing user experience. Vaccination should be recommended to prevent the development of high-grade precancerous cervical lesions in women. The new iOS & Android mobile apps and the Web application , to streamline navigation of the guidelines, have launched. Any updates to this document can be found on www.acog.orgor by calling the ACOG Resource Center. R.S.G. this threshold undergo surveillance, while risks above this threshold, but below the expedited treatment threshold, 2020;24(2):102131. Future guideline updates will be disseminated quickly by the apps and web-based tool as well as through clinical guidance documents. Gynecol Oncol 2015;136:17882. A Practice Advisory is a brief, focused statement issued within 24-48 hours of the release of this evolving information and constitutes ACOG clinical guidance. Read the new ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and Do not perform cervical cytology (Pap test) or HPV screening in immunocompetent women younger than 21 years. Management guidelines FAQs. Data from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. Vaccination is the primary method of prevention. Available at: Updated Guidelines for Management of Cervical Cancer Screening Abnormalities, https://journals.lww.com/jlgtd/Fulltext/2020/04000/2019_ASCCP_Risk_Based_Management_Consensus.3.aspx, https://journals.lww.com/jlgtd/pages/collectiondetails.aspx?TopicalCollectionId=2, https://www.asccp.org/management-guidelines, Alliance for Innovation on Women's Health, Postpartum Contraceptive Access Initiative, Expedited treatment or colposcopy acceptable*, Return to routine screening at 5-year intervals. endstream endobj 1177 0 obj <. treat). Risk estimation will use technology, such as a smartphone application or website. endstream endobj 1018 0 obj <>/Metadata 94 0 R/OCProperties<>/OCGs[1045 0 R]>>/Outlines 114 0 R/PageLayout/SinglePage/Pages 1009 0 R/StructTreeRoot 177 0 R/Type/Catalog>> endobj 1019 0 obj <>/ExtGState<>/Font<>/Pattern<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1020 0 obj <>stream Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible If everything is correct, click next and move on to the recommendations page. No industry funds were used in the development of Management of results during post colposcopy surveillance (within past 7 years): Management of current HPV and/or cytology results for patients who previously were triaged to 1-year, 3-year or 5-year follow-up after colposcopy. 2f8 Hf8*@r9MXNw6JXbc```3=20(.bbc`Sb0 Z This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. Similar considerations exist for a patient who is referred with a moderate Pap smear who has completed child bearing. Funding for these activities is for the research related costs of the trials. x][s~wj- 3JJ$*H>LA7C@&=v"`g3~.J~zw$N_%(r[Tii^V_tD$D+Aw8Ry]Q/>*_c{I3&TMZ{u6t7J35Il]~5H"j4jP^M$:^#:_kz]H,T AmR-h6/~p|`_M,6e%cDvE8+"KT =5A7Bed,V9W#O=26TE"MWfg(IGcU|H^i\G \%?&tU bWiS ]LPI-jb0> Huang, MD; Warner Huh, MD; Michelle Khan, MD, MPH; Jane Kim, PhD; Rachel Kupets, MD; Margaret Long, MD; Thomas Lorey 104 0 obj <> endobj 1017 0 obj <> endobj Dr. Castle has received HPV tests and assays at a reduced or no cost from Roche, Becton Dickinson, Arbor Vita Corporation, and Cepheid for research. It is not intended to substitute for the independent professional judgment of the treating clinician. Pap-HPV cotesting is performed every 5 years in women older than 30 with past normal screening. J Low Genit Tract Dis 2020;24:132-43. the 2019 ASCCP risk-based management consensus guidelines. the consensus process is available. With a more nuanced understanding of how prior results affect risk, and more This Practice Advisory was developed by the American College of Obstetricians and Gynecologists in collaboration with David Chelmow, MD. Algorithms and/or risk estimates are shown when available. If HPV testing is not performed on ASC-US results, then repeat cytology in 6 to 12 months is recommended, with colposcopy referral for ASC-US or higher. time. Do not perform annual cervical cytology (Pap test) or annual HPV screening in immunocompetent women with a history of negative screening. J Low Genit Tract Dis 2020;24:10231. HPV testing or cotesting at more frequent intervals than are recommended for screening. PMC Copyright, 2002, 2006, 2013, 2019, 2020 ASCCP. %%EOF 2) Notice this recommendation looks different. Colposcopy is also recommended if a patient has 2 consecutive HPV positive results and an exact risk estimate is not available. 1 0 obj Patients with symptoms such as abnormal uterine or vaginal bleeding or a visibly abnormal-appearing cervix require appropriate diagnostic testing as this may be a sign of cancer. Obstet Gynecol 2013;121:82946. Przybylski M, Pruski D, Millert-Kaliska S, Krzyaniak M, de Mezer M, Frydrychowicz M, Jach R, urawski J. Biomedicines. your express consent. high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert endstream endobj startxref /+=jYOu3jz;?oVX'm6HtW|`k* HPV-based testing: this term is used in this document to describe the use of either cotesting or primary HPV Although most HPV infections are transient and subclinical, some lead to clinical manifestations ranging from benign papillomas or warts to intraepithelial lesions. Vaccination is ideally administered at 11 or 12 years of age, irrespective of the patient's sex. undergo colposcopy. HPV infection is the most common sexually transmitted infection in the United States. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2020;24:10231. J Low Genit Tract Dis. A Pap test looks for abnormal cells. Bethesda, MD 20894, Web Policies National Library of Medicine Human Papillomavirus (HPV) Vaccine Guidelines The American Cancer Society recommends HPV vaccination for boys and girls between ages 9 and 12. 2020 Oct;24(4):426. doi: 10.1097/LGT.0000000000000562. 2 0 obj determine a patient's care. endobj For all management indications, HPV mRNA and HPV DNA tests without FDA approval for primary screening alone should only be used as a cotest with cytology, unless sufficient, rigorous data are available to support use of these particular tests in management. test results in isolation, the new guidelines use current and past results to create individualized assessments of a The recommendation is for colposcopy. The following clarifications specify management for additional scenarios. management from one that is based on specific test results to one that is based on a patient's risk will allow for The nonavalent HPV vaccine is effective in preventing the development of high-grade precancerous cervical lesions in noninfected patients. Perkins, Rebecca B. MD, MSc1; Guido, Richard S. MD2; Castle, Philip E. PhD3; Chelmow, David MD4; Einstein, Mark H. MD, MS5; Garcia, Francisco MD, MPH6; Huh, Warner K. MD7; Kim, Jane J. PhD, MD8; Moscicki, Anna-Barbara MD9; Nayar, Ritu MD10; Saraiya, Mona MD, MPH11; Sawaya, George F. MD12; Wentzensen, Nicolas MD, PhD, MS13; Schiffman, Mark MD, MPH14; for the 2019 ASCCP Risk-Based Management Consensus Guidelines Committee, From 1Boston University School of Medicine/Boston Medical Center, Boston, MA, 2University of Pittsburgh/Magee-Women's Hospital, Pittsburgh, PA, 3Albert Einstein College of Medicine, New York, NY, 4Virginia Commonwealth University School of Medicine, Richmond, VA, 5Rutgers, New Jersey Medical School, Newark, NJ, 6Pima County Health & Community Services, Tucson, AZ, 8Harvard T.H. 2012 updated consensus guidelines for the management of abnormal cervical In this case, management of routine screening results is the appropriate selection. endstream endobj startxref In patients 21 to 29 years of age, cervical cancer screening should be performed every three years using cervical cytology alone. For additional quantities, please contact [emailprotected] 0 Screening Options x}[;#7p8Bcxd?>!]tG6P(T"?~/owov8r;5q{O'_i5vv`-aw:]q)x3^U|b?|U@ e 8v\T!&0>a>jy!01 6Q(;[ fawgN;L`ZilsL0"*0L~=P#zIC+yt1gjo%u:bRRoK|~RV 5*G|~E>*/r{e:++|fBAWnfeR5c5{NTyF Affiliations. USPSTF guidelines 13. Author disclosure: No relevant financial affiliations. 18 We don't have any prior history in this particular case. *For nonpregnant patients 25 years or older. 140, Management of Abnormal Cervical Cancer Screening Test Results and Cervical Cancer Precursors. Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible The site is secure. It does not apply to reflex HPV testing for triage of ASC-US Michael Gold, MD; Robert Goulart, MD; Richard Guido, MD; Paul Han, MD; Sally Hersh, DNP; Aimee Holland, DNP; Eric and R.S.G. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. One of the most important updates to the guidelines is the recognition of the importance of previous human papillomavirus (HPV) test results. Consistent with prior guidance, screening should begin at age 21 years, and screening recommendations remain unchanged for average-risk individuals aged 21-29 years and those who are older than 65 years Table 1. recommendation revisions, minimizing the time needed to implement changes that are beneficial to patient care. -, Massad LS, Einstein MH, Huh WK, et al. ZKlX#`Q)s4 OhMaoJDk4*L!ivm *k^xtY3 u|yHU& Df3u Use of condoms and dental dams may decrease spread of the virus. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Please enable it to take advantage of the complete set of features! Read all of the Articles Read the Main Guideline Article Management Guidelines The last 10 years of research has shown that risk-based management allows clinicians to 2020 Apr;24(2):132-143. doi: 10.1097/LGT.0000000000000529. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. The 2019 ASCCP Risk-Based Management Consensus Guidelines1 represent a paradigm shift from using primarily results-based algorithms to using risk-based management based on a combination of current screening test results and past screening history. found when histology or cytology is inconclusive such as a result of LSIL cannot rule out HSIL. Therefore, we click no for prior history and click next. Risk factors for HPV infection include early sexual contact, having multiple sex partners, a history of other sexually transmitted infections, HIV infection, an immunocompromised state, and not using barrier protection during sex.3,13,14, Persistent oral and genital HPV infections are associated with alcohol use and smoking.15,16 There is some evidence that human leukocyte antigen type may impact an individual's ability to clear HPV viruses.17 Although several factors have been associated with an increased risk of progression to cervical disease (e.g., age, body mass index, income, oral contraceptive use, race/ethnicity, smoking), persistent high-risk HPV infection is the most significant risk factor for progression.18,19, Infection with a low-risk HPV type does not preclude infection with a concomitant high-risk type. 21 Clearly defined risk thresholds based on the results of HPV tests, alone or in conjunction with cytology, are used to guide management (more or . which test combinations yielded this risk level. Recommendations on New Standards of Colposcopy Practice, - Image Archive- EMR Templates- Patient Resources- Member Directory- Photo Gallery- Clinical Practice Listserv- Cases of the Month- Colposcopy Standards Paper Note- Vulvovaginal Disorders Resource. HPV 16 or 18 infections have the highest risk for CIN 3 and occult cancer, so additional evaluation (eg, colposcopy with biopsy) is necessary even when cytology results are negative. 1075 0 obj <>stream effective and invasive cervical cancer can develop in women participating in such programs. -, Huh WK, Ault KA, Chelmow D, et al. %PDF-1.5 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors J Low Genit Tract Dis . Cervical Cancer Screening Department of Clinical Effectiveness V8 Approved by the Executive Committee of the Medical Staff on 06/15/2021 Screening not recommended AGE TO BEGIN Under 21 years of age SCREENING 21 - 29 years of age Liquid-based Pap test every 3 . If you are 21 to 29 Have a Pap test alone every 3 years. J Low Genit Tract Dis. 2019 ASCCP risk-based management consensus guidelines for abnormal Schiffman, Wentzensen: The National Cancer Institute (incl. J Low Genit Tract Dis. This information is not intended for use without professional advice. Squamous Intraepithelial Lesion (SIL): A term used to describe abnormal cervical cells detected by the Pap test. Your message has been successfully sent to your colleague. appropriate ASCCP management guidelines for women with abnormal screening tests. Before Click the "next" button. Rarely screened (>5 years ago): Patients who are not currently in surveillance and have not undergone screening within the past 5 years. J Low Genit Tract Dis 2020;24:10231. Introduction of risk- based guidelines in 2012 was a conceptual He has been the overall PI or local PI for clinical trials from Johnson&Johnson, Pfizer, Iovance, and Inovio. Guidelines. Perkins RB, Guido RS, Castle PE, et al. specimen for histologic analysis, such as Loop Electrosurgical Excision Procedure (LEEP), Large Loop Excision of the Specifically, the 2012 guidelines recommend colposcopy for all cytology results of low grade squamous intraepithelial lesion (LSIL) or higher for individuals aged 25 and above. Disclaimer. Therefore, incorporating HPV testing into risk stratification and recommendations for surveillance following abnormal results was an important part of the 2019 guidelines. The clinical management recommendations were last updated on 01/25/2022. 3 0 obj ET). American Society for Colposcopy and Cervical Pathology. 1186 0 obj <>/Filter/FlateDecode/ID[<4119F28666E0954E9D1B9856E3FE9044>]/Index[1176 17]/Info 1175 0 R/Length 65/Prev 464723/Root 1177 0 R/Size 1193/Type/XRef/W[1 2 1]>>stream high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert v/3`N.f3E@Z5 CF/FKMsW3 qWr08#h5Zu=/7|J`nX9h a`Th00liN`q@*:D1@ s Erin Nelson, MD; Akiva Novetsky, MD, MS; Rebecca Perkins, MD; Jeffrey Quinlan, MD; Mona Saraiya, MD; Debbie Saslow, By using the app, you agree to the Terms of Use and Privacy Policy. %PDF-1.6 % The ASCCP recommendations are available in a web-based application and mobile apps for iPhone, iPad, and Android devices. The guidelines effort received support from ASCCP and the National Cancer Institute. endobj Histopathological follow-ups within six months were also reviewed for correlation. Updated guidelines published in October 2007 place greater emphasis on testing for high-risk human papillomavirus (HPV). Disclosure of Financial Support: The guidelines effort received support from the National Cancer Institute and ASCCP. sharing sensitive information, make sure youre on a federal Evaluation of a colposcopic biopsy: Management of biopsy results after colposcopy. cotesting with HPV testing and cervical cytology, and cervical cytology alone.

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